9080-3 Establishment Application for Export

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UNITED STATES DEPARTMENT OF AGRICULTURE
FOOD SAFETY AND INSPECTION SERVICE

2. DATE OF REQUEST

ESTABLISHMENT APPLICATION
FOR EXPORT OF
MEAT

4. DISTRICT OFFICE (Name and Number)

OTHER

POULTRY

TO: USDA/FSIS/OIA, EXPORT STAFF
1400 Independence Ave., SW
Room 2137S
Washington, DC 20250

3. COUNTRY (To which product will be exported)

OFFICE OF INTERNATIONAL AFFAIRS

5. USDA ESTABLISHMENT NO.

PHONE: (202) 720-6400
(202) 720-7990
FAX:

6. FROM: (Establishment name and address as shown on current Grant of
Inspection, FSIS Form 5200-1, and include DBA's if applicable)

(Check if Voluntary Inspection)
9. TYPE OF
OPERATION(s)
(Check)

10. CLASS OF PRODUCT(s) TO BE EXPORTED
03B Raw Product-Ground

Slaughter

03C Raw Product-Not Ground

Boning/Cut-up

03D Thermal Processed/Com. Sterile
03E Not Heat Treated-Shelf Stable (S.S.)

Grinding

03F Heat Treated-Shelf Stable

Processing

03G Fully Cooked/Not Shelf Stable
Cold Storage

03H Heat Treated/Not Fully Cooked-Not S.S.

Other

03I

Product With Secondary Inhibitors-Not S.S

11. SPECIES

7. PHONE NO.
8. FAX NO.

Beef

Pork

Sheep/Lamb

Chicken

Turkey

Duck

Ratite

Bison

Wild Game

Other

12. The undersigned requests that the firm identified in Item 7 be included on the list of establishments certified by USDA as meeting the requirements
of the country specified with respect to the importation of meat/poultry or meat/poultry products. The export requirements and other references may
be obtained from the USDA FSIS Export Library at www.fsis.usda.gov/OFO/export/explib.htm.
We make this request with the understanding that, in addition to compliance with normal U.S. inspection requirements, the above-named firm
voluntarily agrees to the following:
To comply with all provisions of appropriate inspection laws and regulations of the importing country when preparing
product for export to that country. These requirements have been reviewed by officials of this firm and are fully
understood.
To reimburse USDA for any inspections over and above U.S. requirements, (Reference FSIS Directive 5110.1).
To segregate and maintain identity of product eligible for export from noneligible product.
To operate in the mode to meet the importing country's requirements anytime an export audit is made by a U.S. review
team or by a foreign official.
To notify appropriate FSIS officials promptly when firm wishes to be removed from the list of plants that are eligible to
export to the country named herein (Item 3).
13. SIGNATURE OF AUTHORIZED FIRM REPRESENTATIVE
(Type or Print Name Above Signature)

16. NAME OF CONTACT PERSON IF DIFFERENT FROM ABOVE

15. DATE SIGNED

17. TITLE

18. PHONE:

19. FAX:

FSIS SECTION (Type or Print Name Above All Signatures)
20. I surveyed the above-named establishment on the date indicated below and in my opinion, it meets the requirements for export to

(Name of Country)

, subject to comments if any on the attached correspondence.
22. DATE SURVEYED

21. SIGNATURE OF INSPECTOR-IN-CHARGE

23. SIGNATURE OF CIRCUIT SUPERVISOR/DATE

24. SIGNATURE OF DISTRICT MANAGER/DATE

25. NAME OF RECEIVING OFFICIAL AT OFFICE OF INTERNATIONAL AFFAIRS (if applicable)

FSIS FORM 9080-3 (12/30/2003)

(PREVIOUS EDITIONS OBSOLETE)

26. DATE RECEIVED AT OIA (if applicable)

Designed on Delrina FormFlow Software.

INSTRUCTIONS FOR FSIS FORM 9080-3
Purpose:
For most countries, all FSIS-authorized meat, poultry and egg product establishments are eligible to
export meat, poultry and egg products, provided all requirements indicated in the Library of Export
Requirements (http://www.fsis.usda.gov/OFO/export/explib.htm) are met. Several countries,
however, require additional certification provided by the plant and approved by FSIS. The country
requirements listed in the Library of Export Requirements will reflect the necessity of this additional
certification process if required. Plants wishing to export to such countries should submit this FSIS
Form 9080-3 to the Office of International Affairs.

Instructions:
Complete FSIS Form 9080-3 in its entirety. All fields must be filled in order to process the request.
The completed form should be faxed or mailed to the Office of International Affairs, the contact
information for which appears on the form.

Approval:
Once submitted, the Office of International Affairs will process the request with the appropriate
foreign authorities. Upon receiving approval, the plant information will be posted on the Library of
Export Requirements under the list of approved plants for the appropriate country. Users should
check the Library of Export Requirements to see when their plant has been approved. Users may
also contact the Office of International Affairs for an update on the status of the application.